**- 



HB 881 
.R2 
Copy 1 



THE INFLUENCE OF VITAL 
STATISTICS ON LONGEVITY 



BY 



DR. WATSON S. RANKIN 

Secretary North Carolina Board of Health, Raleigh, N. C. 



* 



An Address delivered at the Sixth Annual Meeting of the 

ASSOCIATION OF LIFE INSURANCE PRESIDENTS 

At New York, December 5, 1912 






fl*? 



THE INFLUENCE OF VITAL STATISTICS ON 
LONGEVITY 

By Dr. Watson S. Rankin 

Secretary, North Carolina Board of Health, Raleigh, N. C. 

AN ADDRESS DELIVERED AT THE SIXTH ANNUAL MEETING OF THE 

ASSOCIATION OF LIFE INSURANCE PRESIDENTS IN 

NEW YORK CITY ON DECEMBER 5, I912 



Vital statistics to increase longevity must be available as a remedy 
for the treatment of sick bodies politic — sick towns, sick cities, sick 
counties and sick States. Applied vital statistics, with all the em- 
phasis on the qualifying term, is the most essential and powerful 
remedy for the improvement of the health of social organisms, for 
bringing about sanitary reform, for preventing disease, for postpon- 
ing death and for adding years to the duration of the average life 
that we possess. It is the sole purpose of this paper to make good 
this last statement. To do so it is incumbent upon me to point out 
just how this remedy, applied vital statistics, acts upon sick towns, 
cities and States, or, if a more comprehensive but technical term be 
permitted, to point out the physiological action of applied vital 
statistics on a sick social organism. 

Now, the first effect of applied vital statistics on a diseased body 
politic — a sick town, city, county or State — is to 

RESTORE CONSCIOUSNESS 

I have never known a sick town, city, or community whose aggre- 
gate potential mind was conscious of its illness. Let me illustrate 
with concrete cases. However, I wish to emphasize that the concrete 
cases which I shall detail illustrate fundamental principles of general 
application. 

1 



Case I. — A city of 20,000 population, one of the best cities in my 
State, the health conditions of which are shown in charts Patient Z : 
Chart 2 and Patient Z : Chart 3. Were the people of that city con- 
scious of the condition shown on the charts? Let's see. Five of the 
most representative and intelligent citizens of the city were called 
over the telephone and asked to answer two questions without re- 
questing any explanations from their interrogator. One of the five 
was a college president, another a State official, another a practising 
physician, another a banker and the other one a leading merchant. 
The first question asked each of them, independently, was: What 
is your opinion of the health of your city ? As if it were a grave sin 
against their patriotism to consider such a question for even a mo- 
ment, they all unhesitatingly answered "good." The Second ques- 
tion, which immediately followed their answer to the first, was : 
How many people would you say died in your city last year? With 
some verbal sparring, with noticeable hesitation, all the five realizing 
that their answer to the first question presupposed ability to answer 
the second question, the answers came. Three said there were 60, 
one 100, and one 300 deaths a year. As a matter of fact there were 
508 deaths, but 72 less than the sum of the guesses. These were 
representative citizens, and their answers to the questions pro- 
pounded showed how unconscious the people of that city were of 
their real health situation. 

Case II. — I was called in consultation by a board of aldermen 
and board of county commissioners to consider and advise with them 
regarding the effect on a county town's health of a small pool of 
water, covering, I suppose, a half acre of ground, and situated right 
over the municipal boundary line. 

After looking over the pond in the morning and making a general 
sanitary survey of the town, I walked over to the local registrar's 
office to see how many people were dying and what they were dying 
from. At five o'clock I consulted with the Board of Aldermen, 
several physicians, and health officers and others. I called their at- 
tention to the fact that the small collection of water was but one 
very small item for consideration in their health situation; that 
malaria had caused very few deaths in their town, and it was doubt- 
ful if the pond had much to do with their malaria, as there were so 
many other breeding places for mosquitoes ; that with a little ditch- 
ing and kerosene oil (I went into details), the pond could be 
dismissed as a health menace; that whereas the pond was of little 
consequence, other conditions of health in their city were of grave 



consequence ; that, taking statistics from their own official, they had 
a death rate of 27.5 per thousand, which meant 12.5 people out of 
every thousand of their population died in excess of the average 
death rate that obtained throughout the United States ; that for four 
thousand population this meant an annual unnecessary loss of fifty 
lives to their town; that even if they had a death rate of fifteen, some 
of the fifteen would be from preventable diseases, and, therefore, the 
fifty lives lost must necessarily be regarded as excessive preventable 
deaths ; that their records showed a death rate from tuberculosis of 
three hundred and seventeen per one hundred thousand, instead of 
the average of one hundred sixty-seven; that their records showed 
a death rate from typhoid of seven and one-half times the average ; 
that during the last winter their town had had its share of deaths 
from measles for sixty years; that this last fact meant one of two 
things : either an extremely malignant epidemic, the improbable ex- 
planation, or more probably inefficient quarantine, the probable 
explanation ; that they were most inconsistent in having required 
a railroad that passed through the town to build an overhead bridge 
at a cost of $18,000, because during ten years the railroad had killed, 
at a crossing, as many as ten people ; that the interest on the original 
investment of the railroad, and the wear and tear of the bridge, 
would amount to at least $1^500 per year, which they were forcing 
the railroad to spend to prevent one needless death ; that while they 
were requiring the railroad to spend $1,500 to prevent one death, 
they, the aldermen, were spending only $150 to prevent -fifty deaths. 

My consultants were easily convinced that the puddle of water 
was insignificant as compared with their real health situation, of 
which they, until that meeting, were totally unconscious. I could 
cite other examples, but I have gone into details sufficiently to es- 
tablish the principle that the 'first thing to do in treating sick social 
organisms is to restore consciousness. 

The best way in which to administer the remedy of applied vital 
statistics to sick social organisms is in the form of charts. Those 
on the wall are some that I have used in discussing municipal health 
with the citizens of several North Carolina municipalities. When 
such facts as those shown on the charts fail to bring about favorable 
changes in the sanitary administrations of a sick municipality, the 
charts should be published — given to the papers. In this way com- 
munity pride, where community intelligence is lacking, will be 
awakened through adverse outside criticism and results obtained. 

The following tables were shown in the form of cloth charts 
thirty-six by thirty-six inches : 

3 



Chart Demonstrating Unenforced Lazv Requiring Reporting of 
Certain Diseases 

PATIENT Z : CHART I 

Cases Actual Average 

Diseases Reported Deaths Fatality Fatality 

Tuberculosis 27 54 200% 10-25% 

Typhoid Fever 48 11 23% 10% 

Whooping Cough 13 10 76.9% 10% 

Measles 31 5 16% 5% 

Diphtheria 28 4 14% &% 



Death Rates 



PATIENT Z : CHART 2 

Death Rates 



InZ 



General 27.6 

White 25 

Colored 40 

Tuberculosis 270 

Typhoid Fever 55 

Diarrheal Diseases (under 2 yrs.) 215 

Whooping Cough 50 

Measles 25 

Scarlet Fever o 

Diphtheria 20 



In Average City 

in the 

United States 

15. 

16.5 

26.2 

160.3 

23-5 
100.8 
11.4 
12.3 
11.6 
21.4 



PATIENT Z : CHART 3 

Total Deaths 

Would Occur With 
Causes Occurring Average Death Excessive 

All Causes 508 300 208 

White Population 326 208 118 

Colored Population 280 112 168 

Tuberculosis 54 33 21 

Typhoid Fever 11 5 6 

Diarrhoeas (under 2 yrs.) .43 19 24 

Whooping Cough 11 2 8 

Measles 5 2 3 

Diphtheria 4 4 o 

Scarlet Fever o 2 Credit 2 lives 

4 



PATIENT Z : CHART 4 

Ages of Decedents 

Percentages of Deaths Case I 

Children under 15 30.5 

Wage Earners, 15-50 32 

Above 50 37.2 

Above 60 23.4 



For United States 

30.5 
28 
41.4 
3i-3 



PATIENT O: CHART I , A ~.. 

In Average City 

Death Rate In Q in United States 

General 22.8 1 5 

White 16 16 ) In Southern 

Colored 37 26.2 j cities 

Tuberculosis 329 160.3 

Typhoid Fever 211 23.5 

Diarrhoeas (under 2 yrs.) 282 100.8 

Whooping Cough 82 11.4 

Measles 35 12.3 

Scarlet Fever 1 1.7 1 1.6 

Diphtheria 47 21.4 

Following closely upon the first action of applied vital statistics, 
the second effect — 



THE INAUGURATION OF SANITARY REFORM 

begins to be manifest. In Case I mentioned above, a health organi- 
zation had been at work for more than a year without producing 
tangible results when the facts shown on charts, Patient Z,were made 
public. One explanation after another was then advanced by the 
local press to explain why conditions were different in that town 
from other towns. For example, the first explanation was that in 
that city there were a number of colleges, and people retiring from 
business brought their children there to be educated — in other words, 
that the senile population of that city was larger than that of the 
average city. Then Chart 4, Patient Z was prepared, and that ex- 
planation set aside. Finally, when the defense had exhausted its ex- 
cuses, those advocating sanitary reforms were asked if they knew 
any reason why the city of blank should be more unhealthy than 
the average city. Then attention was called to Chart I, Patient Z, 
and the defense was asked if they could name a more fundamental 
or important health law than that requiring the reporting of con- 



PATIENT Q: CHART 2 

Seasonal Variation in Deaths by Races 




tagious and infectious diseases by which the extension of the infec- 
tion could be circumscribed. Of course they could not. Chart I 
makes it perfectly evident that that law was absolutely disregarded. 
Attention was then called to the violations of the milk ordinance. 
Of 190 bacteriological examinations the preceding year 90 were 
found bad and absolutely nothing done. Other unsanitary conditions 
explanatory of the high death rates were also pointed out. Within 
eight months of the publication of these facts that city has let a 
contract for a thoroughly modern municipal owned abattoir, has 
employed a graduate veterinarian of experience for his entire time 
as a food inspector, has extended its sewer connections and has en- 
larged the district in which fly-proof sanitary privies are required. 

In case two, after the consultation above referred to, the municipal 
authorities ordered the town clerk to make requisition of the State 
Board of Health for sufficient copies of the Monthly State Board of 
Health Bulletin to distribute them each month to every family in the 
incorporate limits of the town. The county authorities directed their 
health officer to select the names of from 1,000 to 2,000 of the best 
citizens of the county and have their names placed on the mailing 
list for the health literature distributed by the State Board of Health. 
At present I regard that county as one of the most promising in my 
State for sanitary progress. "Ye shall know the truth and the truth 
shall make you free." 

The third effect of our remedy, applied vital statistics, is nothing 
more than a consummation of the second effect — 

A RESPONSIBLE HEALTH OFFICER 

As a rule, and any way ultimately, an efficient health officer will 
be required to give his entire time to his official duties. It is just 
about as impossible for a health officer to look after his own interest 
in private practice and the public's in health work as it is for a man 
to serve both God and mammon. The great need of the country, 
and especially of the South, is the whole-time health officer. But any 
way, whether our local — county or municipal — health officer is whole 
time or not, he will be, when employed as an effect of applied vital 
statistics, responsible. Here comes in the fourth and last and most 
important action of our remedy, namely, its effect in furnishing 

AN EFFICIENCY STANDARD OF HEALTH WORK 

Every health officer must stand squarely on this platform : Health 
work that is worthy the name means the prevention of disease; the 
prevention of disease means the prevention of deaths ; the prevention 

7 



of deaths means one of two things : either the retention of an average 
death rate or the reduction of a high death rate. Applied vital statis- 
tics, therefore, furnish the only check the people can have on their 
health officer, the only means by which they can discriminate between 
the true and the counterfeit. If a health officer has been employed 
for some time, say two or three years, and can show no influence on 
the death rates of his jurisdiction it is time to make a change in the 
health office. 

The fourth effect of applied vital statistics, the elimination of the 
unfit from health service, is especially valuable in furnishing central 
health authorities, like State boards of health, the only means of 
control, in accordance with democratic principles of government, of 
local health officers — county and municipal. Most State boards of 
health are provided with publicity means in the form of monthly 
bulletins. If, at the end of each registration year, the counties of 
the State and the municipalities of the State are tabulated in the 
order of the lowest to the highest death rate and this tabulation 
published, a restoration of health consciousness among the sick 
counties, those in greatest need of and most amenable to sanitary 
reform, will be effected; if, in the same issue of the bulletin, the 
county and municipal health officers are published, in tabulated form, 
in the order of those with the biggest influence on death rates, that 
is the best health officer, to those with least or no effect on death 
rates, the worst health officer; if the photographs of one or two of 
the best health officers in the State, those with the greatest reduction 
in death rates, are published in this bulletin, and a description of 
the methods by which they accomplished their results also published, 
a high standard of efficiency for health officers will be popularized 
and the people will demand that it shall be met. 

I recognize that this scheme of health administration is strongly 
biased by considerations arising from the standpoint of State health 
administration and that it neglects the important details and methods 
by which the local health officers — municipal and county — are to 
effect the reduction of death rates. This defect is only apparent and 
not real, as many methods will be experimented with by as many 
local health officers, and those that are worthless in time rejected and 
those that produce results retained. 

In conclusion, the physiological effect of applied vital statistics on 
sick social organisms is (i) to restore civic health consciousness, 
(2) to enforce sanitary reforms where they are most needed, (3) to 
result in the employment of responsible health officials, and (4) to 
apply that great fundamental law of nature, the survival of the 
fittest, to the selection of health officers. 

8 



LIBRARY OF CONGRESS 



013 738 046 8 # 



\ 



LIBRARY OF CONGRESS 



013 738 046 8 



